18 Aug A Life Lesson in Cost-Awareness
By Christi Lucus, RN, BSN
It was July 2012 and I was pregnant with my third child. As an experienced mother and labor and delivery nurse, I felt very comfortable at 29 weeks gestation and anticipated the usual course of pregnancy. However, at 30 weeks, I started battling with preterm labor issues. This eventually led to the early delivery of my son, a four week and stay in the NICU, and a life lesson in cost-awareness of medical care.
My third child, Alex, was due October 8, 2012. My husband and I were thrilled to be expecting our second son. As for myself, I anticipated a fairly normal pregnancy, since there were few issues in my previous two. My prior pregnancy with my daughter was a bit stressful at the end. I began preterm labor with her at 32 weeks gestation, but under the watchful eye of my obstetrician and nurse-midwife, I was advised to be on bed rest and given Procardia for my contractions. At 38 weeks, she was born healthy and happy with no complications.
After another military move 2011, my husband and I settled into our new area with our family and I found a new OB practice to continue with my medical care. When I entered into care with my third pregnancy, I made sure my previous preterm labor issues were documented into my history. With 9 physicians in the practice, 1 nurse practitioner, and 1 physicians assistant, I never saw the same care provider twice. However, I was happy to be able to meet each one of them so I would see a familiar face at my delivery. My pregnancy progressed as normal, with no issues until 29 weeks gestation.
At 29 weeks, I began experiencing contractions. As an experienced labor and delivery nurse, I knew the difference between Braxton Hicks and true contractions. I also knew what I needed to do to take care of myself. At 30 weeks, the contractions became worrisome, as they were getting stronger. It didn’t matter how much I rested or drank, they were still there. At 31 weeks, I was admitted to the hospital to be monitored and my contractions persisted, every 7-10 minutes. After being monitored a full night and given the usual treatments, I was discharged home the next day with instructions to follow up that week if they continued. They continued, so I followed up with one of the doctors, lab work and ultrasound confirmed that everything was fine. I was instructed to return to the hospital if the contractions continued to grow stronger. At 32 weeks, they were stronger. Admitted for monitoring again, I was given IV fluids and monitored throughout the night. Contracting every 5-7 minutes this time, I requested Procardia and Betamethasone. The doctor on call insisted I did not need that since my cervix was holding steady at 3cm, and I was sent home.
Frustrated with the care I had received (actually the lack thereof), I decided to return to my hometown and see the doctors that had cared for me in my prior pregnancy. After being home approximately 10 hours, I started into active labor. By then, it was too late for my doctors to help me, so I was transferred to the nearest hospital with a NICU. After 1 hour of labor, my son was born at 32 weeks gestation. Since he had not received the Betamethasone I had previously requested, he needed breathing assistance and was placed on a ventilator. After two doses of surfactant, he transitioned to bi-pap. After the first five days, he could breath completely on his own. Over the next three weeks, his goal was to eat and gain weight. As with many preemies, his stay in the NICU was full of ups and downs. At week 2 he became septic and suffered and ileus. He was given many antibiotics, some very new that I had never heard of. During his stay he had multiple abdominal x-rays, a PICC line was placed, numerous lab tests, etc. The staff and doctors that cared for him show exemplary care. At what would have been 36 weeks gestation, he was discharged home without further complications and very healthy.
A month or so later, my lesson in cost-awareness began. As the bills for his NICU stay came, I was truly amazed. Even working in the nursing profession, I had no idea his bills would be so high! His NICU stay alone was a little over $70,000, radiology was around $9,000, and the physicians bill was around $10,000. Thankfully, my husband is active duty military, and our insurance covered all but $36.00. It still makes me wonder, how much would it have cost to give me Betamethasone and Procardia? Would I have delivered early had I been given it? Would my son have had the same complications had I been given the steroids in time? I will never know the answer to those questions, but as a patient and a nurse, I would have much rather been given the opportunity to get the preventatives than nothing.
Overall, Tricare may have saved thousands had I been given the anticipatory care I was seeking. As a current nurse practitioner student, I definitely see the value in screening and preventative care. As I begin my advanced practice career in the near future, I will always carry my personal experience with me and the lessons I learned from it.
Christi Lucus, RN, BSN was a 2013 Costs of Care Essay Contest.